Examine current approaches to addressing social determinants of health (SDOH) in the NICU and perceived appropriateness of a standardized screening and referral process.
We performed a mixed methods study in two Massachusetts safety-net NICUs. We examined rates that unmet basic needs were assessed and identified among 601 families. We conducted focus groups with NICU staff to understand current methods to assess unmet basic needs and perceived appropriateness of a standardized SDOH screening and referral process.
Except employment (89%), other unmet basic needs were infrequently assessed (housing 38%, food/hunger 7%, childcare 3%, transportation 3%, utilities 0.2%). Staff believed: (1) processes to assess SDOH were not standardized and inconsistently performed/documented; (2) addressing SDOH was important; and (3) using a standardized screening and referral process would be feasible.
Current NICU assessment of SDOH is limited and use of a standardized screening and referral process could be useful.
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Social Determinants of Health. World Health Organization. https://www.who.int/social_determinants/sdh_definition/en/ (2020).
Marmot M. Social determinants of health inequalities. Lancet. 2005;365:1099–104.
Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. Annu Rev Public Health. 2011;32:381–98.
Poverty and Child Health in the United States. Council on Community Pediatrics. Pediatrics. 2016;137:e20160339.
Kaiser Family Foundation. A view from the states: key medicaid policy changes: results from a 50-State Mediciad Budget Survey for State Fiscal Years 2019 and 2020. https://www.kff.org/report-section/a-view-from-the-states-key-medicaid-policy-changes-delivery-systems/ (2020).
Profit J, Gould JB, Bennett M, Goldstein BA, Draper D, Phibbs CS, et al. Racial/ethnic disparity in NICU quality of care delivery. Pediatrics. 2017;140:e20170918.
Howell EA, Janevic T, Hebert PL, Egorova NN, Balbierz A, Zeitlin J. Differences in morbidity and mortality rates in Black, White, and Hispanic very preterm infants among New York City Hospitals. JAMA Pediatr. 2018;172:269–77.
Janevic T, Zeitlin J, Auger N, Egorova NN, Hebert P, Balbierz A, et al. Association of race/ethnicity with very preterm neonatal morbidities. JAMA Pediatr. 2018;172:1061–9.
Lewis TP, Andrews KG, Shenberger E, Betancourt TS, Fink G, Pereira S, et al. Caregiving can be costly: a qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit. BMC Pregnancy Childbirth. 2019;19:227.
Greene MM, Rossman B, Patra K, Kratovil A, Khan S, Meier PP. Maternal psychological distress and visitation to the neonatal intensive care unit. Acta Paediatr. 2015;104:e306–13.
Parker MG, Sandel M, Frank D, Garg A. Unmet material needs among low-income families of US preterm infants. Philidelphia, PA: Pediatric Academic Societies; 2020.
Ivankova NV, Creswell JW, Stick SL. Using mixed-methods sequential explanatory design: from theory to practice. Field Methods. 2006;18:3–20.
Garg A, Toy S, Tripodis Y, Silverstein M, Freeman E. Addressing social determinants of health at well child care visits: a cluster RCT. Pediatrics. 2015;135:e296–304.
Bernard RH. Research methods in anthropology: qualitative and quantitative approaches. Walnut Creek: Altamira Press; 2002.
DeNavas-Walt C, Proctor BD. Income and poverty in the United States: 2014. 2014. https://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-252.pdf. Accessed 21 Aug 2020.
Sokol R, Austin A, Chandler C, Byrum E, Bousquette J, Lancaster C, et al. Screening children for social determinants of health: a systematic review. Pediatrics. 2019;144:e20191622.
Vasan A, Kenyon CC, Palakshappa D. Differences in pediatric residents’ social needs screening practices across health care settings. Hosp Pediatr. 2020;10:443–6.
Joseph RM, O’Shea TM, Allred EN, Heeren T, Kuban KK. Maternal educational status at birth, maternal educational advancement, and neurocognitive outcomes at age 10 years among children born extremely preterm. Pediatr Res. 2018;83:767–77.
Linsell L, Malouf R, Morris J, Kurinczuk JJ, Marlow N. Prognostic factors for poor cognitive development in children born very preterm or with very low birth weight: a systematic review. JAMA Pediatr. 2015;169:1162–72.
Beck AF, Edwards EM, Horbar JD, Howell EA, McCormick MC, Pursley DM. The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatr Res. 2020;87:227–34.
Pursley DM, McCormick MC. Bending the arc for the extremely low gestational age newborn. Pediatr Res. 2018;83:751–3.
Shapiro N, Wachtel EV, Bailey SM, Espiritu MM. Implicit physician biases in periviability counseling. J Pediatr. 2018;197:109–15 e101.
We acknowledge the NICU staff that participated in our focus groups and the families that are cared for at the BMC and UMass NICUs. We acknowledge Alyssa Fliter, Mikayla Gordon Wexler, Archana Kalyanasundaram, Jordi Negron, Stephanie Philip, Stephen Rogers, Lindsey Simoncini, and Heather White for their assistance with data collection. This work was supported by the National Institute of Minority Health and Health Disparities (R01MD007793; PI Garg).
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Parker, M.G., Garg, A., Brochier, A. et al. Approaches to addressing social determinants of health in the NICU: a mixed methods study. J Perinatol (2020). https://doi.org/10.1038/s41372-020-00867-w